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CHAIN OF CUSTODY /LABORATORY ANALYSIS REQUEST FORM Page—of_ <br /> Shaw Environmental P.O.No: Direct Bill San Joaquin County <br /> 1326 North Market Boulevard, Sacramento,CA 95834 J`/✓ ,�J / Lab: CAS,Simi Valley <br /> Project Name:Foothill Landfill,San Joaquin County Analysis Requested <br /> Project Number: 124591 (Ground Water) <br /> b <br /> Report to: Sheila Richgels o <br /> Company: Shaw Environmental c <br /> U <br /> Address: 1326 North Market Boulevard G N y H <br /> Sacramento, CA 95834 t j ¢ w 0 <br /> w 0-. A o z � <br /> Dir Ph: (916) 565-4327 / F (916) 65-4356 0 0 o b <br /> 1 U z <br /> Sampler's Signature: t1 t ""t n U v; o <br /> z Q U z U U REMARKS <br /> Sample LAB Sample 11 von Uterl.PE 250m1 5001711 6 Container Types <br /> 1.D. Date Time I.D. Matrix HCl NP NP H903 NP Preservations <br /> - water <br /> MW-2R -lk co water 8 3 1 1 1 2 <br /> MW-3 water 8 3 1 1 1 2 <br /> MW-5 -- <br /> water 1 1 <br /> Field Blank h. ' 0-A ;j water 2 2 <br /> Trip Blank 1� t")y water 2 2 <br /> RELINQUISHED BY RECEIVED BY RELINQUISHED BY, RECE D B TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X 1. Routine Report <br /> Si tur Signature Signature S'gnat(u�re 21 hr 48 hr 5day II. Report(includes DUP,MS <br /> t�) 1 t{n.lf 4 X Standard(-10-15 workingdays) MSD,as required,maybe <br /> Pritffe Name. PrintedPrinted Name Printed Name Printed Name Provide Verbal Preliminary Results charged as samples) <br /> T)-e Y�14�4�7� <br /> Provide FAX Preliminary Results III.Data Validation Report <br /> Fi Fir Firm Firm Requested Report Date: (includes All Raw Data) <br /> ~� <br /> X RWQCB <br /> Date/Time 2• .Cf, Date/Time Datdrime Da ime (MDLs/PQLsfrRACE#) <br /> RELINQUISHED BY RECEIVED BY Special Instructions/Comments: Container Types Key: <br /> Columbia Analytical 40 ml VOA: 1 <br /> Signature Signature Please report MDLs,PQLs and Trace. 2655 Park Center Drive,Suite A 250 ml LPE: 2 <br /> Nitrate-Nitrogen has a 48-hr hold time. Simi Valley,CA 93065 500 ml LPE: 3 <br /> Printed Name Printed Name 805-526-7161/Fx 805-526-7270 1 liter HDPE: 4 <br /> Contact: Karen Ryan 500 ml glass: 5 <br /> Firm Firm UPS Acct 9653E1 1 liter glass: 6 <br /> EDDs to<susan.waterman@shawgrp.com> 2x6 s/s ring: 7 <br /> Dat Dateffime glass jar: 8 <br />